1. A home health nurse prepares to teach a Latino patient who neither speaks nor reads English how to measure and administer insulin. Which teaching tool should be the most helpful?
a. Booklet from the American Diabetes Association explaining the effects of too much or too little insulin
b. Nutrition pamphlet explanation discussing amounts of each food group needed each day
c. Alarm clock, magazine pictures showing sunrise and sunset, several clean insulin syringes, and insulin bottles filled with colored water
d. Large sheet explaining the need for washing hands, times, amounts of insulin to inject, and the nurses home phone number
ANS: C
If the patient has been assessed as not being able to process written or spoken English, providing literature is futile. A nutrition pamphlet has nothing to do with injecting insulin. Pictures and a clock are universal symbols that are readily understood. Return demonstrations with the actual syringe are good learning exercises.

2. A young Asian wife of a businessman recently transferred to the United States is brought to the hospital for an emergency appendectomy. The nurses make every effort to plan correct care. Which term best describes the integration of cultural concepts into the nursing care plan?
a. Assimilation of culture
b. Cultural diversity
c. Enculturation of the patient
d. Transcultural nursing
ANS: D
The health team must be sensitive to an Asian patients preference for alternative health care measures such as herbalists and medication, as well as understand that pain is endured quietly, without complaint.

3. A nurse is clearing the bedside area to give a bed bath to a Muslim woman the day after a cesarean section. What action should the culturally sensitive nurse implement?
a. Pick up and move the copy of the Koran so it will not be soiled with bath water.
b. Ask the patient to remove the taviz to prevent it from being touched by a non-Muslim.
c. Offer a quiet time after the bath for prayer.
d. Be especially protective of her modesty.
ANS: D
Muslim women are extremely modest and prefer clothes that cover the entire body. The Koran is not to be handled by any non-Muslim person, and the taviz is worn at all times. Muslim women are excused from prayer for 40 days after childbirth.

4. A nurse is caring for a young woman who is a member of the Church of Jesus Christ of Latter Day Saints (Mormon).What should be offered as an appropriate snack by the nurse?
a. Juice and cookies
b. Tea and a piece of fruit
c. Coffee and a cinnamon roll
d. Cola drink and chips
ANS: A
The Mormon faith abstains from the use of beverages with caffeine such as cola, coffee, and tea. Juice and cookies do not violate the dietary habits.

5. Two licensed practical/vocational nurses (LPN/LVNs) are colleagues on the same medical-surgical floor. They went to the same LPN/LVN school. When on break time, they discuss the holistic entries of the nursing care plans they are helping create. What does this behavior exemplify?
a. Subculture
b. Democracy
c. Diversity
d. Ethnicity
ANS: A
Professional nursing is a subculture that is learned in the professional school and experienced by practitioners in practice settings, such as a hospital break room, where nurses of a similar subculture can address patient care planning issues to provide holistic nursing care.

6. At the request of the family, an instructor makes an assignment change for a black male student who had been assigned to take care of a postpartum Muslim woman. What is the most likely reason that the request was made by the family?
a. Muslim culture does not allow black practitioners to care for women.
b. Muslim culture prefers that women health care providers care for Muslim women.
c. The husband will be present, and he will object.
d. After childbirth, all care must be performed by women.
ANS: B
The cultural aspects of a patient must be respected. Muslims prefer female care providers for women because of the extreme modesty of Muslim women.

7. A severely injured man is brought into the emergency department after an automobile accident and is given two units of O-negative blood while waiting for a cross-match to be completed for the other 4 units of blood that the physician has ordered. The nurse discovers a card identifying the man as a Jehovahs Witness. What is the most appropriate nursing action?
a. Inform the laboratory to hold the process on typing and crossmatching the 4 units of blood.
b. Call the hospital administration to obtain a court order to intervene.
c. Inform the physician that the patient is a Jehovahs Witness.
d. Remove all tourniquets and cardiac monitoring devices.
ANS: C
Jehovahs Witnesses do not permit the infusion of blood or blood products under any circumstances. The physician who ordered the blood transfusion must be notified immediately.

8. A nurse is leading a discussion with a group of residents of a Jewish long-term care facility. When discussing dietary laws and other religious practices, what should the nurse anticipate as the most prominent need of these patients?
a. Fasting every Friday night from sunset until sunset on the following Saturday and not taking them to the dining room
b. Having a quiet time for prayer provided before and after all meals
c. Serving meat and milk products at the same time but on separate plates
d. Allowing Jewish men to shave before their Sabbath
ANS: B
The Jewish religion observes a prayer ritual before and after meals. Fasting is usually done only for Yom Kippur. Meat and milk are not served together in a meal. Jewish men retain their facial hair but only cut it with scissors, not with a shaver.

9. A Filipino man is admitting his elderly mother to a long-term care facility for custodial care. During the intake interview, the man is alternately tearful and defensive. To what Filipino belief does the culturally competent nurse assess this labile behavior as being related?
a. Medical facilities are a place of death.
b. Families should care for the older family members at home.
c. His language barrier is causing him to be misunderstood.
d. Such facilities will limit visitations from the family.
ANS: B
Filipino culture prides itself in its ability to care for their older family members in the home. Family ties are very strong, and visits by many family members are an indication of their love and concern.

10. A Japanese patient, hospitalized for arteriosclerotic heart disease and hypertension, is allowed to have a regular diet with cultural provisions of Asian food. A diuretic, antibiotic, bronchodilator, and vasodilator have been prescribed. Which medication would be hampered by an Asian diet?
a. Bronchodilator
b. Vasodilator
c. Diuretic
d. Antibiotic
ANS: C
The Japanese diet is rich in sodium, which may interfere with the efficacy of a diuretic medication.

11. A patient of Chinese descent is in the community clinic for treatment of arthritis. The patient tells the nurse that the disease is a hot disease. The nurse assesses that the patient is referring to the hot-cold theory. What cause is attributed to hot diseases?
a. Bodys reaction to hot weather
b. Excessive blood and yellow bile
c. Invasion of hot or evil thoughts, causing the body to react
d. Overeating cold foods
ANS: B
Persons of Chinese descent believe that disease is caused by the four humors, which get out of balance and cause a hot or cold disease. Blood and yellow bile are considered hot.

12. A nurse has scheduled a specific time for a group of Latino patients with diabetes to come for diabetic teaching, but the group does not come until almost an hour later. What should the culturally competent nurse suspect has occurred?
a. The language barrier caused a miscommunication.
b. Denial about the disease has delayed arrival.
c. Their culture places little significance on the concept of time.
d. Timely arrival is rude because it may inconvenience the hostess.
ANS: C
Some cultures place little to no significance on formal time and appear late or not at all for appointments.

13. Transcultural nursing care is expected for every patient. To provide this type of care, the nurse needs to understand the practices of the predominant cultures of those groups in the health care geographic area. What should this require the nurse to be aware of?
a. Culture influences beliefs about health, illness, and health practices.
b. All members of an ethnic group have the same beliefs about health practices.
c. A patients culture rather than individual assessments can be the basis of care.
d. Members of subcultures must be encouraged by nurses to adopt the dominant culture.
ANS: A
Transcultural nursing assumes that the nurse is aware of the beliefs about health, illness, and health care practices of the individual being cared for and has added these concepts into the care planning, implementation, and evaluation of practice.

14. After a Jewish woman has given birth and returns to her room, the husband arrives with a camera. What is the best response for the culturally sensitive nurse?
a. Here is a chair near the door so you can be comfortable while you visit.
b. Ill give you all some privacy because I know you want to give your wife a big hug.
c. Let me get some instructions for you to follow in her home care after she is discharged this afternoon.
d. Sit on the bed and put your arm around your wife, and I will take your photograph.
ANS: A
The Jewish woman who has just given birth is considered unclean and cannot be touched by her husband until blood flow has stopped.

15. What should be included in a patients care plan in consideration of cultural similarities?
a. Family, educational background, and economic level should all be considered.
b. Subtle communication involving languages should be considered.
c. Families have strong patriarchal leaders.
d. Culture is learned, shared, and expressed similarly among members.
ANS: D
Different cultures have some similarities and some differences. How the culture is expressed in health care settings will be diverse.

16. As breakfast trays are served, a Catholic patient asks the nurse to take it away, because a priest is coming to administer Communion. What is the best response by the nurse?
a. You really need this nutrition. I have to leave it for you. Regardless, you must eat.
b. I will leave the tray in the kitchen. You may call me to bring it back when it is time.
c. You must eat your breakfast before it gets cold. If the priest comes, tell him to wait for you.
d. Communion is only another piece of bread, so it will go just fine with your eggs.
ANS: B
Unless in danger of death, Catholics need to fast for at least 15 minutes before and require a period of quiet time after receiving Communion.

17. A nurse is planning the delivery of transcultural nursing care. Which is the best approach for the nurse to select?
a. Facilitys chaplain if anything special should be included in the care plan
b. Patient if any special foods, symbols, or practices should be respected and whether they should be included in the health care plan
c. Family if anything special exists in the patients culture or religion that should be included in care planning
d. Other staff if they have ever had this type of patient before and how they modified the care plan
ANS: B
The patient, when able, is the only person who can answer this question.

18. A nurse learns at report that a patient is a member of a Seventh-Day Adventist group. At mealtime, which trays should be served to this patient?
a. Corn flakes with whole milk, cranberry and orange juices, buttered muffin, and coffee
b. Mixed salad with chunks of chicken, potato salad, orange juice, and a small apple
c. Scrambled eggs and crisp bacon, melon slice, wheat toast, and hot tea
d. Broiled flounder, scalloped potatoes, yellow squash, green bean salad, rice pudding, and coffee
ANS: B
This religion forbids the eating of pork products (bacon) and drinking strong beverages such as tea and coffee.

19. A practicing Hindu patient is dying but has orders for a full diet. However, the patient will accept only soups. Which is the most appropriate food for the nurse to order for this patient?
a. Beef broth with bits of tomatoes and potatoes
b. Pured tomatoes, carrots, celery, and potatoes in a vegetable stock
c. Chicken stock with rice noodles and celery
d. Finely chopped roast beef and mashed rice with vegetable broth gravy
ANS: B
Members of certain Hindu sects are vegetarians.

20. A nursing assistant reports to the nurse, The Hindu patient in room 4 is not responding but is breathing, and his skin is warm and dry. What should the culturally sensitive nurse recognize as the probable cause of this behavior?
a. Karma
b. Yoga trance
c. Moksha
d. Caste atonement
ANS: B
This Hindu man is attempting to reach the highest level of meditation in Yoga, during which he may become totally unresponsive.

21. An Orthodox Jewish patient has died at 0300 on a Wednesday, and no family member was present. What intervention should the culturally competent nurse implement before the family arrives?
a. Avoid touching the body until an Orthodox Jew arrives.
b. Call the hospital chaplain to come and stay with the body.
c. Place the patients copy of the Koran at the bedside.
d. Wash the body and straighten up the room.
ANS: A
Death practices of this group are very strict. However, in the absence of family, the body should not be touched. No non-Jewish person should touch the body. The Koran is the religious guide for those of the Muslim faith.

22. What is the term for cultures and subcultures existing within the same society, as they do in the large cities of the United States?
a. Cultural diversity
b. Cultural ethnicity
c. Mixed society
d. Cultural immigration
ANS: A
The correct term for cultural groups within the society is cultural diversity.

23. A nurse is aware that slow drug metabolism can cause oversedation with some tranquilizers and sedatives. What culture is this characteristic most likely to represent?
a. Chinese
b. Indian
c. Native Americans
d. Latinos
ANS: A
Recent tests have found that persons of Chinese and Japanese descent have an alteration in liver enzymes that slows the metabolism of some tranquilizers and sedatives, which results in oversedation of these drugs.

24. In what alternate health care practice do Latino individuals believe? (Select all that apply.)
a. Use of a folk healer
b. Folk remedies
c. Self-mutilation
d. Sweating in a smoke tent
e. Use of peyote
ANS: A, B
Using folk healers (curanderos or curanderas) and folk remedies are components of the Latino culture. Self-mutilation, sweating, and using peyote are associated more with the American Indian culture.